Chronic Oral Sensory Disorder Pain and Abnormalities of Taste

ERNA SULISTYANI

Chronic Orofacial Pain

Persistent pain in some cases without physical

abnormalities. Presistent pain bisa terkait dengan faktor trauma, infeksi, neoplasia, gangguan metabolisme, gangg. Neurogenic. Inflamasi, dan psikitatrik. The nervous system can no longer be regarded as a simple feed-forward relay for sensory stimuli. It must be considered a complex transducer, processor, interpreter and pathologic generator. It is a highly reactive system and on a occasion may react inappropriate and unfavorable ways. Pain = Nyeri

Taxonomy of Pain

Definition : Pain is unpleasant sensory and

emotional experience associated with actual or potential tissue damage, or describe in terms of such damage. Pain is always subjective. Pain in the absence of tissue damage usually happens for psychological reasons.

 Allodynia: sakit oleh krn stimulus yg normalnya tdk

menyebabkan sakit. Hyperalgesia: peningkatan respon thdp stimulus yg memang sakit. Hyperesthesia: peningkatan respon terhadap sesuatu yang mengganggu (bukan sakit ) misalnya suhu, getaran) Hyperpathia: painfull syndrome, peningkatan reaksi thdp stimulus, peningkatan ambang rasa sakit, tidak bisa mengidentifikasi dan menunjukkan lokasi stimulus, berlangsung lama dan menyebar.

 Causalgia: syndrome burning pain, allodynia and

hyperpathia after traumatic nerve lesion. Hypoesthesia:decrease sensitivity to stimulation Hyphoalgesia: response to a normally painfull stimulus is diminished. Neuralgia: pain in the distribution of nerve. Neuropathy: Disturbance of function or pathologic change of nerve. Nociceptor: pheripheral receptors preferentially sensitive to noxious stimuli. Parasthesia: abnormal (but not unpleasent sensation) whether spontaneous or evoked

 Dysesthesia: An unpleseant abnormal sensation.

Anesthesia dolorosa: Paradoxic pain in a region of

sensory loss following an injury to a cranial nerve or nerve root. Central Pain: pain associated with a lesion of CNS.

Evaluation of patient with chronic orofacial pain. History

Chief complaint and history of present illness. Kata2 yg digunakan ut menggambarkan rasa sakit yang dirasakan, onset, progress, dampak terhadap pekerjaan maupun hubungan sosial, Dari riwayat rasa sakit ini kadang diagnosa bisa dibuat atau dipersempit. Hal yg perlu dicatat, intensitas, kualitas, lokasi, onset, lamanya. Faktor yg meringankan dan meningkatkan rasa sakit dsb. Informasi yg terkait dengan onset rasa sakit tersebut harus digali lebih mendalam. Spt kesehatan psikis dan fisik, perubahan link kerja, keluarga dan lingkungan sosial.

Intensitas : kuat ringan rasa sakit. fluktuasi rasasakit spontan, waktu tertentu, aktivitas atau posture. Kebiasaan2 mengunyah permen karet, clenching dan grinding yg kadang tdk disadari px. Efect dari eating distraction, rest, exercise, heat and cold on pain. Penyebaran rasa sakit perlu juga dideterminasi dengan jelas. pusat rasa sakit dan penyebarannya.

Past medical history

Some chronic pain are associated with systemic

illness. Current medical use, OTC, obat dgn resep, obat@ rumahan, allergi obat dan adverse reaction. Bbrp obat mempunyai efek samping yg berperan dalam tjdnya rasa sakit spt fatique, dizzines, anxiety, insomnia, parasthesia and frank tissue iritation.

Family, social and occupational history.

Penyakit pd keluarga atau saudara sedarah

mengindikasi adanya faktor lingkungan atau herediter. Faktor lain: marital status, education, pekerjaan, emotional stressfull event mungkin berhubungan dengan penyebab rasa sakit itu.

Physical examination
Pemeriksaan fisik bisa mengindentifikasi perub

pathologis atau pd byk kasus membantu diagnosis yang diambil saat anamnesis. Meskipun tidak ada kelainan yg ditemukan pemeriksaan klinis tetap harus dilakukan ut menyingkirkan dugaan adanya kelainan2 yg serius. Sensory discrimination, muscle strength, range of motion, soft tissue palpation, intraoral exam, TMJ auscultation and palpation and complete cranial nerve exam,

 Sensory discrimination, Tested with small sterile

needle or pin yg dimasukkan kedalam kulit sesuai dgn dermatomenya. Mata pasien terpejam. Asymetric respons, hyperalgesia, hypoalgesia dicatat. Muscle strength: evaluated by isometric contraction muscless and palpation. Range of motion: movement that elicit pain and non painfull movement.